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ABSTRACT Background: Screening tests have been used for cognitive deficits in Parkinson's disease (PD). Objective: This study compared the Montreal Cognitive Assessment (MoCA) test, the Mini-Mental State Examination (MMSE) and the clock drawing test for this purpose. Methods: A total of 50 patients with PD were selected, 41 (82%) were diagnosed with dementia by the criteria of the Movement Disorder Society. The test Scales for Outcomes in Parkinson's Disease-Cognition (SCOPA-Cog) was used as the gold standard in comparison with the screening tests. Results: The MoCA test (AUC=0.906) had a sensitivity of 87.80% and specificity of 88.89%. When the MMSE was associated with the clock drawing test (AUC=0.936), it had a specificity of 66.67% and sensitivity of up to 97.56%. Conclusion: The study suggests that the MoCA test can be a good screening test in PD. However, MMSE associated with the clock drawing test may be more effective than the MoCA test.

RESUMO Embasamento: Diversos testes têm sido utilizados como ferramenta de triagem para déficits cognitivos na doença de Parkinson (DP). Objetivo: Este estudo comparou os testes Montreal Cognitive Assessment (MoCA), Mini Exame do Estado Mental (MEEM) e teste do relógio para essa finalidade. Métodos: Foram selecionados 50 pacientes com DP, dos quais 41 (82 %) foram diagnosticados com demência pelos critérios da Movement Disorder Society. O teste Scales for Outcomes in Parkinson's Disease-Cognition (SCOPA-Cog) foi usado como padrão-ouro na comparação com os testes de triagem. Resultados: O teste MoCA (AUC=0,906) apresentou sensibilidade de 87,80% e especificidade de 88,89%. Quando o MEEM foi associado ao teste do relógio (AUC=0,936), apresentou especificidade de 66,67% e sensibilidade de até 97,56%. Conclusão: O estudo sugere que o teste MoCA pode ser um melhor teste de triagem na DP. Entretanto, o MEEM associado ao teste do relógio pode ser mais eficiente que o MoCA.

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Neuropsychiatric symptoms and pain are among the most common nonmotor symptoms of Parkinson's disease (PD). The correlation between pain and PD has been recognized since its classic descriptions. Pain occurs in about 60% of PD patients, two to three times more frequent in this population than in age matched healthy individuals. It is an early and potentially disabling symptom that can precede motor symptoms by several years. The lower back and lower extremities are the most commonly affected areas. The most used classification for pain in PD defines musculoskeletal, dystonic, central, or neuropathic/radicular forms. Its different clinical characteristics, variable relationship with motor symptoms, and inconsistent response to dopaminergic drugs suggest that the mechanism underlying pain in PD is complex and multifaceted, involving the peripheral nervous system, generation and amplification of pain by motor symptoms, and neurodegeneration of areas related to pain modulation. Although pain in DP is common and a significant source of disability, its clinical characteristics, pathophysiology, classification, and management remain to be defined.

RESUMEN

BACKGROUND: Screening tests have been used for cognitive deficits in Parkinson's disease (PD). OBJECTIVE: This study compared the Montreal Cognitive Assessment (MoCA) test, the Mini-Mental State Examination (MMSE) and the clock drawing test for this purpose. METHODS: A total of 50 patients with PD were selected, 41 (82%) were diagnosed with dementia by the criteria of the Movement Disorder Society. The test Scales for Outcomes in Parkinson's Disease-Cognition (SCOPA-Cog) was used as the gold standard in comparison with the screening tests. RESULTS: The MoCA test (AUC=0.906) had a sensitivity of 87.80% and specificity of 88.89%. When the MMSE was associated with the clock drawing test (AUC=0.936), it had a specificity of 66.67% and sensitivity of up to 97.56%. CONCLUSION: The study suggests that the MoCA test can be a good screening test in PD. However, MMSE associated with the clock drawing test may be more effective than the MoCA test.

EMBASAMENTO: Diversos testes têm sido utilizados como ferramenta de triagem para déficits cognitivos na doença de Parkinson (DP). OBJETIVO: Este estudo comparou os testes Montreal Cognitive Assessment (MoCA), Mini Exame do Estado Mental (MEEM) e teste do relógio para essa finalidade. MÉTODOS: Foram selecionados 50 pacientes com DP, dos quais 41 (82 %) foram diagnosticados com demência pelos critérios da Movement Disorder Society. O teste Scales for Outcomes in Parkinson's Disease-Cognition (SCOPA-Cog) foi usado como padrão-ouro na comparação com os testes de triagem. RESULTADOS: O teste MoCA (AUC=0,906) apresentou sensibilidade de 87,80% e especificidade de 88,89%. Quando o MEEM foi associado ao teste do relógio (AUC=0,936), apresentou especificidade de 66,67% e sensibilidade de até 97,56%. CONCLUSÃO: O estudo sugere que o teste MoCA pode ser um melhor teste de triagem na DP. Entretanto, o MEEM associado ao teste do relógio pode ser mais eficiente que o MoCA.

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Background. Orthostatic hypotension (OH) is an important nonmotor manifestation of Parkinson's disease (PD). Changes in cerebrovascular reactivity may contribute to this manifestation and can be monitored using transcranial Doppler. Objective. To identify possible changes in cerebrovascular reactivity in patients with OH. Methods. Twenty-two individuals were selected and divided into three groups: with and without OH and controls. Transcranial Doppler was used to assess basal mean blood flow velocity, postapnea mean blood flow velocity, percentage increase in mean blood flow velocity, and cerebrovascular reactivity as measured by the breath-holding index. Results. PD patients had lower values of basal velocity (p = 0.019), postapnea velocity (p = 0.0015), percentage increase in velocity (p = 0.039), and breath-holding index (p = 0.04) than the controls. Patients with OH had higher values of basal velocity (p = 0.09) and postapnea velocity (p = 0.19) but lower values of percentage increase in velocity (p = 0.22) and breath-holding index (p = 0.32) than patients without OH. Conclusions. PD patients present with abnormalities in a compensatory mechanism that regulates cerebral blood flow. OH could be an indicator of these abnormalities.